Issue link: https://www.massageandbodyworkdigital.com/i/1078860
"addiction" does not appear in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). NIDA has adopted the DSM language—substance use disorder—to describe the situation when a person becomes dependent on a substance for various reasons. Substance use disorder, according to NIDA, is compulsive drug seeking, despite the knowledge and experience of negative consequences. This can occur on a spectrum of severity, from mild to moderate to severe (see Mild, Moderate, or Severe Substance Use Disorder, right). Drug misuse refers to using drugs in unhealthy ways, or in ways not intended— that is, in overly large doses, or use by someone other than the patient. The term abuse is now avoided by NIDA—even though it's in the acronym—because it is seen as stigmatizing and may deter people from seeking appropriate care. The situation we have traditionally called addiction, with increasing tolerance and a need to avoid withdrawal symptoms, is the most severe form of substance use disorder. At this stage, we can expect to see substantial changes in the brain, especially in relation to inhibitions and reward center functions. HISTORY OF OPIUM USE IN THE UNITED STATES Opium has been harvested for human consumption since at least 3400 BCE, but its widespread use didn't become prevalent until the 1800s—largely thanks to the British East India Tea Company (but that's a story for another time). The immigration of Chinese laborers to North America to work on the railroads brought the habit of opium smoking to this continent, and it gained popularity in medical settings as a potent pain reliever during the Civil War. In the early 20th century, opium- based substances, including morphine, cocaine, and heroin, were legal to use without prescription, although they Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 39 were often heavily taxed. Then, in 1909, "smoking opium" was banned; this was the first US law banning the use of a substance for non-medical use. In 1914, all use of opium-related substances was banned, except as directed by physicians. Over the next 75 years or so, guidelines for medical professionals to dispense opioids became increasingly restricted. The downside was serious. People with chronic pain were described as malingerers, deluded, and unworthy of treatment. Pain management was ineffectual, and millions of people with chronic pain had little recourse. Only people dying of cancer were given this pain-relieving intervention. In the early 1990s, the problem of pain management finally began to gain some traction. Physicians were eager to find workable interventions, and a couple of small-scale retrospective observational studies suggested that, in certain very limited circumstances, opioids could be used for intractable pain with little risk of addiction. This led to a loosening of the guidelines for opioid prescriptions, heavy marketing from pharmaceutical companies, and recommendations from many policy-making bodies to treat pain more fully. It helped that oxycodone, a morphine-like drug that can be mixed with non-narcotic pain relievers, was being aggressively (and deceptively) marketed as a low-risk pain reliever. By 2012, doctors in the United States were issuing 282 million prescriptions for opioid pain relievers each year—that's more than one prescription for every adult in the country. At the same time, the number of deaths related to opioid overdose was rapidly climbing. This was the height of opioid prescription writing; but in 2016, (the latest year we have data for) there were still 236 million prescriptions issued. In 2017, 72,000 Americans died from drug overdoses, including prescription and illicit drugs. This represents a twofold increase over the past 10 years. Mild, Moderate, or Severe Substance Use Disorder The following is a condensed version of the DSM-5 criteria for mild, moderate, and severe substance use disorder. While some variances exist for specific substances, the basic pattern is that having 2–3 of these symptoms meets the criteria for mild substance use disorder; 4–5 symptoms form the criteria for moderate substance use disorder; and 6 or more define severe substance use disorder. • The substance is taken in larger amounts and/or over a longer period of time than intended. • The person cannot voluntarily control use. • The person invests a lot of time in accessing, using, and recovering from use of the substance. • The person has a persistent craving for the substance. • Recurrent use leads to a failure to fulfill obligations at work, school, or home. • Use of the substance persists, despite negative consequences. • The person gives up on, or reduces, important activities because of use. • The person uses the substance even in situations that are potentially hazardous. • The person continues use, despite knowledge of physical and psychological problems. • The person develops increasing tolerance: they need more of the substance to achieve the desired sensation, or the same dose results in diminished effect. • The person develops withdrawal symptoms when use is suspended, and they may use the substance to avoid withdrawal symptoms.